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Correlation of a high D-dimer level with poor outcome in traumatic intracranial hemorrhage
Insights
High D-dimer levels in traumatic intracranial hemorrhage (ICH) correlate with poor neurological outcomes. This biomarker, alongside neurological assessment, aids in predicting patient prognosis after head injury.
Area of Science:
- Neurology
- Trauma Care
- Biomarker Research
Background:
- Correlations between D-dimer and neurological status in intracranial hemorrhage (ICH) lack consistency.
- Previous studies have yielded conflicting results regarding D-dimer's predictive value in ICH patients.
Purpose of the Study:
- To investigate the association between D-dimer levels and neurological outcomes in traumatic and non-traumatic ICH.
- To evaluate D-dimer's utility in predicting prognosis in patients with intracranial hemorrhage.
Main Methods:
- Studied 98 traumatic and 59 non-traumatic ICH patients, excluding specific comorbidities.
- Measured D-dimer levels within hours of acute insult.
- Analyzed correlations with Glasgow Coma Scale (GCS), pupillary reflex, CT midline shift, and Glasgow Outcome Score (GOS) using statistical methods and ROC curves.
Main Results:
- Traumatic ICH patients exhibited significantly higher D-dimer levels compared to controls (2984 vs. 256 microg/l; P = 0.001).
- In traumatic ICH, GCS, midline shift, pupillary reflex, and 3-month GOS significantly correlated with high D-dimer (P < 0.001).
- A D-dimer cutoff of 1496 microg/l predicted poor outcome (OR 14.44, P = 0.038) with 100% sensitivity and 83% specificity.
Conclusions:
- Elevated D-dimer levels are significantly associated with poor outcomes in traumatic intracranial hemorrhage.
- D-dimer serves as a valuable adjunct to neurological assessment for predicting prognosis in traumatic ICH.
- The predictive value of D-dimer was specific to traumatic ICH, not observed in the non-traumatic group.
Abstract:
The correlations between D-dimer and Glasgow Coma Scale (GCS), pupillary light reflex, distance of midline shift on brain computed tomography (CT), and Glasgow Outcome Score (GOS) in patients with trauma/non-trauma intracranial hemorrhage (ICH) are not consistent in studies. Ninety-eight traumatic and 59 non-traumatic ICH patients were studied. Pre-existing venous thrombosis, recent surgery, drug use (aspirin or coumadin), or malignancy, were excluded. D-dimer level was estimated within hours after acute insult, and statistical analyses were used for comparisons between groups. Traumatic ICH patients had higher D-dimer levels than controls (2984 vs. 256 microg/l; P = 0.001). The GCS, midline shift on brain CT, pupillary reflex, and GOS at 3 months were significantly correlated with high D-dimer value in traumatic patients (individual P < 0.001), but not in the non-traumatic group. Using receiver-operating characteristic curve (ROC), the cutoff point was 1496 microg/l, with sensitivity and specificity of 100% and 83%, respectively. D-dimer > or =1496 microg/l predicted a poor outcome [adjusted odds ratio (OR) 14.44, 95% CI 1.16-179.27; P = 0.038]. A high D-dimer level is associated with a poor outcome in patients with traumatic ICH. It can be used in addition to neurological assessment to predict the outcome.
